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EMEDPA

More emr hassles

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after several weeks of struggling through our conversion to epic we just discovered that part of the problem is that epic automatically does not give em pa's the ability to order/interpret certain types of tests(like chest xrays). this had nothing to do with our scope of practice but is an arbitrary setting in epic for all pas in em.

my sp and I chewed into them(epic admin) today and demanded that all pas have privileges for all levels of access at the physician level.

nice when the docs stick up for us, both to make our job and theirs easier.

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after several weeks of struggling through our conversion to epic we just discovered that part of the problem is that epic automatically does not give em pa's the ability to order/interpret certain types of tests(like chest xrays). this had nothing to do with our scope of practice but is an arbitrary setting in epic for all pas in em.

my sp and I chewed into them(epic admin) today and demanded that all pas have privileges for all levels of access at the physician level.

nice when the docs stick up for us, both to make our job and theirs easier.

 

I've had trouble with several EHRs and office management softwares that I tested. Besides the problems you mentioned, most of the management software forces you to choose your "hat" and "Physician's Assistant" is one hat. Then, you cannot do any of the things you must do as a practice owner. Then if you put MD, it will put "MD" after your name but allow you to be the owner. You can even be a business-type owner, but then your role cannot be clinical. I've had to write letters and create exceptions for these things.

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the solution on epic is to sign in as an md attending and forward your notes to your sp for cosig.

if you don't do that you can't order or interpret anything....hopefully fixed soon...

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Could be how your shop has EPIC set up. We switched to them in January and I can order all the tests and meds I want, interpret 12-leads, etc.; basically no difference from what I was used to before. I am always signed in as a PA.

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As an ex-Cerner IT consultant and Epic user, this is an easy fix in the Epic build. Just a "highlight and move over" in the build wizard. Submit a ticket and it can be fixed in seconds (once they get to your ticket). It would be worth explaining this to higher level Epic consultants, however, so that they default build for PA privileges is much more extensive for future Epic clients. Because Epic has large (exclusively) clients over many states, they probably set default PA privileges to be minimal, though. Frustrating.

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I can interpret ekg's but not cxr's.

I also can't view MY OWN stats(pts/shift, etc) only my sp can....and this has been more than a month since we first notified them and they are "working on it". they didn't change when I asked before, I had to get my chief to yell at them.

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Sounds like an epic fail.

 

(Can't believe nobody jumped on that yet.)

we've been saying that all month...

even with extra staff we are running 4+ hrs behind, using hall beds, etc

I started a 550 lb guy on bipap and put in an IO in the hallway yesterday....

total cluster...we went from paper+ dictation to epic so something simple like a suture removal goes from a 1 min visit + dictation to 20+ min because the nurses have to get a triage note in before the pt is seen, then we have to fill out a procedure note, etc

it's better than some other emr's I have used(mckesson) but not as good as others(electronic T-system).

I start yet another emr(cerner) at my new rural per diem job thursday.

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Yeah, it's your implementation. I can order anything in EPIC, without cosignature. Last week, I ordered multiple colonoscopies, a HIDA scan, a total knee, and an MRI. No cosignature. Mind you, at the end of each one of those orders is a physician, PA, or trained technologist who is executing things, but the point is that EPIC does what your administrators tell it to.

 

I don't even know how to set something up for cosignature, but I cosign protocol'ed orders by the nurses and MAs all the time.

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we have to do our own coding too...which is reviewed by coders, who then tell us we didn't do it right and ask us to change it....seems like they could just do it themselves, doesn't it?

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We have a simple checkbox for chart co signatures. Attendings only have to sign certain charts; for those we check off the box and pick their name from the list, which puts the chart in their inbox.

 

We did use the coding calculator for a few weeks, but ended up disabling it. The only time the coding people contact us is for something major (eg forgot to include a social history, final dispo, etc).

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in my own practice I had the load myself as an M.D., if I put in it PA or owner it would not allow me to do stuff. This is practice fusion

 

 

Sort of crazy.

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EMR is not built for clinicians - it is built for billing and other back-end processes. My first shift with EMR I saw 1 patient per hour (and not complex patients at that!)

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So today I am at a new rural solo coverage per diem job. the emr here is cerner, which is an ok system. I like electronic -T > epic> cerner but the implementation here has been much better than my recent epic experience detailed in the above posts. the hospital director of I.T. sat next to me and walked me through things, and cleared up several inappropriate default settings for PAs which would not have let me order anything-might have been a problem working alone.

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EMR is not built for clinicians - it is built for billing and other back-end processes. My first shift with EMR I saw 1 patient per hour (and not complex patients at that!)

 

I agree. That is why I've spent the last three months writing my own. I met with a programer on Monday night for about four hours. I think she can take what I've done and carry it through the finish line as a great, tailor-made EHR.

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I saw 7 pts in 12 hrs with the new emr. Granted that was all the pts who presented.(10 here in 12 hrs is considered a busy shift) I probably could have handled double that but more than 1/hr would have been problematic.

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